Safety of the yellow fever vaccine in people living with HIV: a longitudinal study exploring post-vaccination viremia and hematological and liver kinetics

ABSTRACT Background: Safety data on the yellow fever vaccine 17DD in People Living with HIV (PLWH) are limited. This study explored the occurrence of post-vaccination 17DD viremia and the kinetics of hematological and liver laboratorial parameters in PLWH and HIV-uninfected participants [HIV(-) controls]. Methods: We conducted a secondary analysis of a longitudinal interventional trial (NCT03132311) study that enrolled PLWH and HIV(-) controls to receive a single 17DD dose and were followed at 5, 30 and 365 days after vaccination in Rio de Janeiro, Brazil. 17DD viremia (obtained throughreal-time PCR and plaque forming units' assays), hematological (neutrophils, lymphocytes and platelets counts) and liver enzymes (ALT and AST) results were assessed at baseline and Days 5 and 30 post-vaccination. Logistic regression models explored factors associated with the odds of having positive 17DD viremia. Linear regression models explored variables associated with hematological and liver enzymes results at Day 5. Results: A total of 202 PLWH with CD4 > 200 cells/μL and 68 HIV(-) controls were included in the analyses. 17DD viremia was found in 20.0 % of the participants and was twice more frequent in PLWH than in HIV(-) controls (22.8% vs. 11.8 %, p-value < 0.001). Neutrophils, lymphocytes and platelets counts dropped at Day 5 and returned to baseline values at Day 30. 17DD viremia was associated with lower nadir of lymphocytes and platelets at Day 5. ALT levels did not increase post-vaccination and were not associated with 17DD viremia. Conclusions: 17DD was safe and well-tolerated in PLWH with CD4 > 200 cells/μL. Post-vaccination viremia was more frequent in PLWH than in controls. Transient and self-limited decreases in lymphocytes and neutrophils occurred early after vaccination. 17DD viremia was associated with lower lymphocytes and platelets nadir after vaccination. We did not observe elevations in ALT after 17DD vaccination.

Hepatitis A seroprevalence among special populations in the Rio de Janeiro Metropolitan Area, Brazil / Soroprevalência da hepatite A entre populações especiais na Região Metropolitana do Rio de Janeiro, Brasil / Seroprevalencia de la hepatitis A en poblaciones especiales em el Área Metropolitana de Río de Janeiro, Brasil

The objectives were to estimate hepatitis A virus seroprevalence in subjects attending to a travel medicine and immunization clinic in Rio de Janeiro, Brazil, and to develop a prediction model for hepatitis A virus seroprevalence. This retrospective research included individuals sequentially from April 2011 to June 2019 at a travel medicine and special population immunization clinic with an anti-hepatitis A virus IgG chemiluminescence result. Participants' data were verified via electronic medical records. Data were split into development and validation set taking 2018 as the date break. A cross-validated elastic generalized linear model with binomial distribution was performed. In total, 2,944 subjects were analyzed. Hepatitis A virus overall seroprevalence was 67.8%. Health professionals, travelers, and those who had contact with immunocompromised subjects had lower seroprevalence (40%-55%), whereas subjects with chronic conditions (heart, lung, and liver) ranged from 89% to 94%. The retained predictors in the final model were sex, age, year of birth, travelers, HIV/AIDS, spleen dysfunction, transplant candidates, household communicators, cancer-related immunosuppression, health care professionals. Area under the curve was 0.836 and maximum error was 0.051. Users can make predictions with the following calculator: https://pedrobrasil.shinyapps.io/INDWELL/. The groups with lower seroprevalence should be evaluated more carefully regarding need for hepatitis A virus vaccination even when they seek immunization clinics for other purposes.

Este estudo teve como objetivo estimar a soroprevalência do vírus da hepatite A, em indivíduos atendidos em uma clínica de medicina de viagem e imunização no Rio de Janeiro, Brasil, e desenvolver um modelo de predição para a soroprevalência do vírus da hepatite A. Esta pesquisa retrospectiva incluiu indivíduos sequencialmente de abril de 2011 a junho de 2019, em uma clínica de medicina de viagem e uma clínica de vacinação de população especial, que, por qualquer motivo, tem um resultado de quimioluminescência IgG antivírus da hepatite A . Os dados dos participantes foram verificados em prontuário eletrônico. Os dados foram divididos em desenvolvimento e validação, tomando 2018 como data limite da divisão. Um modelo linear generalizado elástico com distribuição binomial submetido a validação cruzada foi aplicado. Foram analisados 2.944 indivíduos atendidos. A soroprevalência geral do vírus da hepatite A foi de 67,8%. Profissionais de saúde, viajantes e contatantes de indivíduos imunocomprometidos apresentaram menor soroprevalência, variando de 40% a 55%, enquanto indivíduos com condições crônicas (coração, pulmão e fígado) tiveram soroprevalência variando de 89% a 94%. Os preditores retidos no modelo final foram sexo, idade, ano de nascimento, viajantes, HIV/aids, asplenia funcional, candidatos a transplante, comunicante domiciliar, imunossupressão relacionada ao câncer e profissionais de saúde. A área sob a curva foi de 0,836 e o erro máximo foi de 0,051. Os usuários podem fazer previsões com uma calculadora (https://pedrobrasil.shinyapps.io/INDWELL/). Os grupos com menor soroprevalência devem ser avaliados com mais cuidado quanto à necessidade de vacinação contra o vírus da hepatite A, mesmo quando procuram clínicas de vacinação para outros fins.

Los objetivos del estudio son estimar la seroprevalencia de hepatitis A en sujetos que asisten a una clínica de medicina para viajeros e inmunización en Río de Janeiro, Brasil, y desarrollar un modelo de predicción de la seroprevalencia de hepatitis A. Esta investigación de seguimiento retrospectivo incluyó a individuos de forma secuencial desde abril de 2011 hasta junio de 2019 en una clínica de medicina para viajeros y de vacunación de poblaciones especiales que por cualquier motivo tienen un resultado de quimioluminiscencia IgG anti-hepatitis A. Los datos de los participantes se verificaron en los registros médicos electrónicos. Los datos se dividieron en conjunto de desarrollo y validación tomando 2018 como fecha de corte. Se realizó un modelo lineal generalizado validado cruzado elástico con distribución binomial. Se analizaron un total de 2.944 sujetos atendidos. La seroprevalencia global del hepatitis A fue del 67,8%. Los profesionales sanitarios, los viajeros y las personas en contacto con sujetos inmunodeprimidos presentaron una seroprevalencia más baja, que osciló entre el 40% y el 55%, mientras que los sujetos con afecciones crónicas (cardíacas, pulmonares y hepáticas) presentaron una seroprevalencia que varió entre el 89% y el 94%. Los predictores retenidos en el modelo final fueron el sexo, la edad, el año de nacimiento, los viajeros, el VIH/SIDA, la disfunción del bazo, los candidatos a trasplante, los comunicadores domésticos, la inmunosupresión relacionada con el cáncer y los profesionales sanitarios. Su área bajo la curva fue de 0,836 y el error máximo de 0,051. Los usuarios pueden hacer predicciones con una calculadora (https://pedrobrasil.shinyapps.io/INDWELL/). Los grupos con menor seroprevalencia deben ser evaluados más cuidadosamente en cuanto a la necesidad de vacunación contra hepatitis A, incluso cuando acudan a las clínicas de vacunación con otros fines.

Travel Medicine in the Dominican Republic / La Medicina del Viajero en República Dominicana

Introduction: Travel Medicine specialty has existed for more than 40 years. However, this is practically unknown by Dominicans despite the large number of people who travel to and from our country. Methods: With the objective of determining the knowledge of Dominicans about the existence of Travel Medicine specialty and their attitudes in relation to it, we conducted a virtual survey of 8 questions, in which 2,584 Dominicans participated. Results: Despite the fact that more than 80 % of those surveyed knew that to travel to certain countries they had to take certain vaccines, less than 25 % had heard of the specialty of Traveler's Medicine. After knowing the definition and objectives of the specialty, more than 90 % of the participants considered it important to consult a specialist prior to the trip. Conclusion: The lack of knowledge of the specialty and the absence of this service in the public health system are the main barriers to the access of Dominicans to the Travel Medicine consultation. It is necessary to publicize the specialty, using scientific evidence and taking as an example the worldwide dissemination of COVID-19 through travelers, to make the population aware of the importance of pre and post-trip consultation, as well as the creation of this service in public hospitals

Introducción: la especialidad Medicina del Viajero existe hace más de 40 años. Sin embargo, esta es prácticamente desconocida por los dominicanos a pesar de la gran cantidad de personas que viajan desde y hacia nuestro país. Material y métodos: Con el objetivo de determinar el conocimiento de los dominicanos sobre la existencia de la Medicina del Viajero y sus actitudes en relación a esta, realizamos una encuesta virtual de 8 preguntas, de la cual participaron 2,584 dominicanos. Resultados: a pesar de que más del 80 % de los encuestados sabían que para viajar a determinados países debían tomar ciertas vacunas, menos del 25 % había escuchado hablar de la especialidad Medicina del Viajero. Tras conocer la definición y objetivos de la especialidad más del 90 % de los participantes consideró importante realizar una consulta previa al viaje con un especialista. Conclusión: el desconocimiento de la especialidad y la ausencia de este servicio en el sistema público de salud son las principales barreras para el acceso de los dominicanos a la consulta de Medicina del Viajero. Es necesario dar a conocer la especialidad, utilizando evidencia científica y tomando como ejemplo la difusión mundial de la COVID-19 a través de los viajeros, concienciar a la población de la importancia de la consulta pre y post viaje, así como la creación de este servicio en hospitales públicos

Barreras para la inmunización en República Dominicana y COVID-19 / Barriers to immunization in the Dominican Republic and COVID-19

En los últimos años la República Dominicana ha experimentado una importante reducción en las coberturas de vacunación, producto de esta situación son los casos de tétanos y difteria que han surgido recientemente. Con el objetivo de identificar las barreras para la inmunización y determinar el impacto de la COVID-19 en la adherencia a la vacunación, 2.584 dominicanos completaron una encuesta en línea sobre el historial de vacunación personal y las razones para no vacunarse. Además, respondieron preguntas sobre la aceptación de la vacuna contra la COVID-19 y la influencia de la pandemia en su percepción/adherencia a la vacunación. La mayoría de los encuestados no se vacunó durante la pandemia, el principal motivo fue: no tenía ninguna vacuna programada para este año. Lo que indica que a pesar de que la pandemia dificultó el acceso a los servicios de vacunación, esta no fue la principal barrera para la inmunización en República Dominicana en el 2020. A pesar de que la mayoría de los participantes están a favor de la vacunación, de las vacunas incluidas en nuestro estudio, la vacuna contra sarampión, rubéola y parotiditis (en niños) fue la única que alcanzó el objetivo del Plan de Acción Mundial sobre Vacunas, de lograr una cobertura de vacunación del 90 por ciento para el 2020. La principal barrera para la inmunización es el olvido de vacunarse. Es necesario adoptar un sistema de recordatorio eficaz para aumentar la adherencia y mejorar las tasas de inmunización(AU)

In recent years, the Dominican Republic has experienced a significant reduction in vaccination coverage; cases of tetanus and diphtheria that have recently emerged are a result of this situation. In order to identify barriers to immunization and determine the impact of COVID-19 on vaccination adherence, 2,584 Dominicans completed an online survey on personal vaccination history and reasons for not getting vaccinated. In addition, they answered questions about the acceptance of the COVID-19 vaccine and the influence of the pandemic on their perception/adherence to vaccination. Most of those surveyed were not vaccinated during the pandemic, the main reason being: I had no vaccination scheduled for this year. This indicates that even though the pandemic made it difficult to access vaccination services, this was not the main barrier to immunization in the Dominican Republic in 2020. Despite the fact that most of the participants are in favor of vaccination, of the vaccines included in our study, the only one that reached the goal of the Global Vaccine Action Plan of achieving 90 por ciento vaccination coverage by 2020 was measles, mumps and rubella in children. The main barrier to immunization is forgetting to get vaccinated. It is necessary to adopt an effective reminder system to increase adherence and improve immunization rates(AU)

Seroprevalence of varicella antibodies in adults without clinical history of disease / Soroprevalência de anticorpos antivaricela em adultos sem história clínica da doença / Seroprevalencia de anticuerpos frente a la varicela en adultos sin historial clínico de la enfermedad

Abstract: Varicella in adults and immunocompromised patients can be severe. The clinical diagnosis of varicella has high accuracy and the history of disease has a high positive predictive value for protection. A significant portion of adults, however, cannot remember if they have had varicella, especially older individuals. We conducted a cross-sectional study to determine the seroprevalence of varicella protective antibodies titers in adults with no clinical history of disease, attended at a Reference Center for Special Immunobiologicals and Travel Medicine in Rio de Janeiro (Brazil). Titration of immunoglobulin G (IgG) antibodies to varicella-zoster was determined by chemiluminescence immunoassay. Among 140 adults without history of varicella, 92% had protective antibody titers. We concluded that seroprevalence of varicella-zoster protection was very high in adults with negative history of disease and the use of serology before vaccination reduced significantly unnecessary vaccine and immunoglobulin use.

Resumo: A varicela é uma doença potencialmente grave em adultos e em pacientes imunocomprometidos. O diagnóstico clínico da varicela apresenta alta acurácia, e o relato da doença na história individual tem alto valor preditivo positivo para a proteção. Entretanto, uma proporção significativa de adultos, principalmente os mais idosos, não se lembra se já teve a doença. Realizamos um estudo transversal para determinar a soroprevalência de títulos protetores de anticorpos contra a varicela em adultos sem história clínica da doença, atendidos em um Centro de Referência para Imunobiológicos Especiais e Medicina de Viagem no Rio de Janeiro, Brasil. Os títulos da imunoglobulina G (IgG) contra varicela-zoster foram determinados por quimiluminescência. Entre 140 adultos sem história de varicela, 92% apresentaram títulos protetores de anticorpos. Concluímos que a soroprevalência de proteção contra varicela-zoster é muito alta em adultos sem história da doença, e que o uso de teste sorológico antes da vacinação reduziria significativamente a vacinação desnecessária e o uso de imunoglobulina.

Resumen: La varicela en adultos y pacientes inmunocomprometidos puede ser grave. El diagnóstico clínico de la varicela tiene una gran precisión y la historia de la enfermedad cuenta con un alto valor predictivo positivo para la protección contra ella. Sin embargo, un porcentaje significativo de adultos, no puede recordar si tuvieron varicela, especialmente las personas más viejas. Realizamos un estudio transversal para determinar la seroprevalencia de las concentraciones de anticuerpos protectores frente a la varicela, en adultos sin historia clínica de la enfermedad, que se llevó a cabo en un Centro de Referencia para Inmunobiología Especial y Medicina del Viajero en Río de Janeiro (Brasil). Se determinó la valoración de los anticuerpos de inmunoglobulina G (IgG) a la varicela-zoster mediante un ensayo inmunológico quimioluminiscente. Entre 140 adultos sin historial de varicela, un 92% tuvieron concentraciones de anticuerpos protectores. Concluimos que la seroprevalencia de la protección a la varicela-zoster fue muy alta en adultos con un historial negativo de la enfermedad y la utilización de la serología antes de la vacunación redujo de manera significativa la vacunación innecesaria y el uso de la inmunoglobulina.

Addressing travelers' perception of risk in pre-travel care: Reports from a travel clinic in Rio de Janeiro, Brazil

Abstract INTRODUCTION: Travel medicine is aimed at promoting health risk reduction. However, travelers' perception of risk is subjective and may influence implementation of recommendations. This study reports on travelers' perception of risk, pre-travel characteristics, and recommended interventions. METHODS: This is a descriptive cross-sectional study. RESULTS: This study included 111 individuals. Most travelers (74%) perceived their risk as low. Significant differences in travel-related risk perception between practitioners and travelers were observed (Gwet's agreement coefficient [AC1] 0.23; standard error 0.10; 95% confidence interval 0.02-0.44). CONCLUSIONS: Future studies should investigate the relationship between travelers' perception of risk and implementation of recommendations.

Danger in the streets: exposures to bloodborne pathogens after community sharp injuries in Rio de Janeiro, Brazil

ABSTRACT Objective: Exposures to sharps injuries occurring in the community are relatively frequent. We describe characteristics of community sharp exposures reported in the city of Rio de Janeiro from 1997 to 2010. Methods: A cross-sectional analysis of exposure reports to sharps in the community reported to a surveillance system, designed for health care workers, of the Municipal Health Department of Rio de Janeiro. The characteristics of exposed individuals analyzed included types of exposure, the circumstances of the accident, and the prophylaxis offered. Results: 582 exposures were studied. Median age was 30 years and 83 (14%) involved children with less than 10 years of age. Two hundred and seventeen (37%) occurred with sharps found in the streets. The exposure was percutaneous in 515 (89%) and needles where involved in 406 (70%) of them. The sharps were present in the trash in 227 (39%) or in the environment in 167 (29%) of the reports. Professionals who work with frequent contact with domestic or urban waste were 196 (38%). The source was known in 112 (19%) of the exposures and blood was involved in 269 (46%). Only 101 (19%) of the injured subjects reported a complete course of vaccination for hepatitis B. Antiretroviral prophylaxis was prescribed for 392 (68%) of the exposed subjects. Conclusions: Sharps injuries occurring in the community are an important health problem. A great proportion would be avoided if practices on how to dispose needles and sharps used outside health units were implemented.